ESHRE Issues 2022 Revision of Endometriosis Guideline

The European Society of Human Reproduction and Embryology has updated its guidelines on the diagnosis and treatment of endometriosis in adolescent and adult women.

The 2022 guideline is a full revision of the previous “Guideline on the Management of Women with Endometriosis” issued in 2014. The new guideline no longer recommends laparoscopy as the criterion standard for the diagnosis of endometriosis. Laparoscopy is now only recommended for patients with negative imaging results or when empiric treatment has proven unsuccessful or is inappropriate.

Regarding treatment for endometriosis pain, the 2022 guideline recommends the use of gonadotropin-releasing hormone (GnRH) antagonists as an additional second-line treatment option. However, danazol and antiprogestogens, antiadhesion agents, laparoscopic uterosacral nerve ablation, and presacral neurectomy are no longer recommended for treating such pain. Moreover, preoperative hormone treatment to improve the immediate outcome of surgery for endometriosis pain is not recommended.

Regarding treatment for endometriosis-related infertility, the Endometriosis Fertility Index was added as a treatment step that can support decision-making regarding the best option for achieving pregnancy after endometriosis surgery. The revised guideline also strongly recommends that women who wish to become pregnant should not receive postoperative hormone suppression solely to enhance future pregnancy rates. In addition, the ultralong protocol, or the extended administration of a GnRH agonist, is no longer recommended before assisted reproductive technology treatment because of its unclear benefit in improving the live birth rate in infertile women with endometriosis.

Compared with the 2014 guideline, the new guideline includes additional information on pregnancy and fertility preservation and more extensive information on menopause and cancer in women with endometriosis.

Endometriosis in adolescents, which was not included in the 2014 guideline, is covered extensively in the new guideline, which devotes a separate chapter to endometriosis recurrence to highlight its importance and challenges.

—Ellen Kurek

Reference:

ESHRE Endometriosis Guideline Development Group. Endometriosis: Guideline of the European Society of Human Reproduction and Embryology. Published online February 2, 2022. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline